Oesophageal dysmotility

Question 1

Pathophysiology of scleroderma causing oesophageal dysmotility?

Answer 1

Blood vessel damage precipitates intramural neuronal dysfunction. Distal oesophageal muscle weakening results, with aperistalsis and loss of LES tone. Reflux –> stricture –> dysphagia.

Question 2

Diagnosis of scleroderma causing oesophageal dysmotility?

Answer 2

CFx of scleroderma + manometry (decreased pressure in LES, decreased peristalsis in body of oesophagus).

Question 3

Rx of oesophageal dysmotility resulting from scleroderma?

Answer 3

Medical: aggressive BD PPIs
Surgery: anti-reflux surgery (fundoplication, gastroplasty).

Question 4

What is diffuse oesophageal spasm?

Answer 4

Normal peristalsis interspersed with frequent, repetitive, spontaneous, high pressure, non-peristaltic waves. Idiopathic.

Question 5

Ix in diffuse oesophageal spasm?

Answer 5

Manometry: >30% contractions aperistaltic

Barium xray: corkscrew pattern

Question 6

Rx of diffuse oesophageal spasm?

Answer 6

• Med: nitrates, CCBs, anticholinergics (variable benefit)

- Surgical: long oesophageal myotomy (rarely helpful); balloon dilatation.